Déterminer des critères cliniques, biologiques et scanographiques prédictifs d'une issue du traitement médical dans le cadre des occlusions digestives sans signes initiaux de gravité

Abstract

Méthodes: Nous avons relu rétrospectivement 221 scanners de patients admis aux urgences pour ! une occlusion aigue du grêle sur phénomènes adhérentielles. Les critères scanographiques notés furent: présence d'une sonde naso-gastrique, localisation de l'occlusion, distension maximale du grêle, rapport entre le diamètre maximal du grele et l'anse d'aval à la zone de transition, présence ou non d'une distension du gastrique ou jéjunale proximale, apposition antérieure. Toutes ces variables ont été comparées entre les patients qui ont été gérés avec succès : par traitement médical et ceux qui ont eu recours à un traitement chirurgical. Résultats: Basé sur l'analyses multivariée, nous avons montré que quatre paramètres étaient significativement associés à la réussite du traitement médical: la durée des symptômes de moins de 18 heures (p = 0,003), le taux de leucocyte 8600x10 6 / L ou plus (p =0,01), une apposition antérieure (p = 0.01) et le nombre de becs (p = 0.005). Conclusion Nous avons trouvé un nouveau signe: l'apposition antérieure, qui n'a jamais été décrit auparavant et il a été associé très fortement à un succès du traitement médical.Methods: We reviewed retrospectively 221 CT of patients for an adhesive small bowel bowel obstruction (ASBO) diagnosis. The following c1inical and biological findings were Iwted: age, sex, previous visceral surgical history, previous history of ASBO, delay between onset of symptoms and CT realization, delay between CT and a possible surgical treatment, tempe rature, C-reactive protein level, leukocyte blood count and lactate deshydrogenase level. The CT features evaluated in our study were: presence of a nasogastric tube, location of obstruction, maximal bowel distension, ratio between maximal bowel diameter and distal small bowel adjacent to the transitional zone, presence or not of a gastric or proximal jejunal distension, anterior apposition, presence of small bowel feces sign and its length, presence of a beak and number of beaks, presence of a closed loop, C- or Ushaped loops, presence of a whirl sign, parietal thickening, presence of a lack of enhancement of bowel wall, mesenteric infiltration and peri oneal infiltration. Ali these variables were compared between the patients who were successfully managed with medical treatment and those who needed surgery. Ali the variables which raised a p-value < 0.2 in univariate analysis were entered in a multivariate model to gauge their independence. Statistical analyses were performed using Computer software (SAS, version 9.3, SAS Institute Cary, NC) Results: Based on mllitivariate analyses, we showed that four parameters were significantly associated with success of medical management: duration symptom of less than 18 hours (p=0,003), leucocyte count 8600x106/L or more (p=O,OI), an anterior apposition (p=O,OI) and beaks number (p=0,005). Conclusion We showed that many findings could have an impact on the management of the non-emergency ASBO. Patients with a leucocyte blood count higher th an 8600x106/L, with number of beak lower or equal to 1 and symptom duration of less than 18 hours were shown to have successful medical treatment. We found a new sign: anterior a position, which was never described before, and it was associated very strongly with success of the nonoperative management.MONTPELLIER-BU Médecine UPM (341722108) / SudocSudocFranceF